A case of embolic stroke due to infective endocarditis predicted in advance with diagnosis confirmed by retrieved thrombus

Abstract

An 84-year-old woman visited our hospital with gastrointestinal bleeding and was hospitalized for suspected colon cancer by abdominal CT. She had a history of atrial fibrillation and she had undergone aortic valve replacement. Warfarin was stopped because PT-INR was excessively prolonged. On the third day of hospitalization, she developed unconsciousness and left hemiplegia, and Magnetic resonance (MR) showed ischemia in the right putamen and corona radiata on diffusion-weighted imaging. MR angiography revealed occlusion of the right middle cerebral artery. T 2weighted imaging showed no susceptibility vessel sign (SVS). She underwent endovascular thrombectomy. As a result, complete recanalization was achieved and white thrombus was retrieved. The pathological diagnosis of the retrieved white thrombus proved that the clump was gram-positive cocci. The pathological examination disclosed the final diagnosis of the embolic stroke due to infective endocarditis, but not atrial fibrillation or malignancy. It is important to predict the characteristics of thrombus from SVS, and if white thrombus is collected, it need to be submitted for pathology.